This brief piece from the Los Angeles Times has some good information, namely that puberty is a tremendously important time for adolescents to be accruing bone mass. Any disruption in puberty, such as from an eating disorder, can cause big problems down the road. Case in point: me. I've lost about half an inch in height from osteoporosis, and I had lost my period for just barely under one year between 20-21. This scares the bejeebers out of me.

Sayeth the Times:

Scientists aren't quite clear on why exactly a woman's fat content makes a difference. Some of that bone accrual is likely a response to the stress caused by the weight her skeleton is carrying; the study's authors also suggest a possible relationship with estrogen levels.

Whatever the underlying causes are, given the post-menopausal specter of osteoporosis, it's important to encourage a healthy body image. Not only is skin-and-bones an unflattering look, it's bad for your bones in the long run.

My problem with the piece is this: it kind of plays into the stereotype that people with eating disorders are a little bit dense, that they are sacrificing health in the name of some ethereal physical trait of beauty. If only they knew they were wrecking their bones, the logic goes, they would just snap out of it! Um, no. That's not how it works. Still, hopefully the knowledge will help discourage dieting (though the cynic in my doubts it...)

The German affiliate of ANAD designed a rather interesting public information campaign to raise awareness of eating disorders. In order to show how beauty ideals have changed over the years, an artist altered famous paintings of women to show how our "cultural ideal" has become essentially anorexic. A short YouTube video on the project is below (if you're easily triggered, don't watch the video. You can pretty much get the idea by using your imaginations).

Although this video helps explain just how messed up our cultural ideals are, I don't quite get how it's supposed to prevent eating disorders. I don't know that these ideals have made eating disorders more "popular." They serve to trivialize eating disorders, and make it hard as hell to recover, that's true. But it doesn't quite resonate with me.

Frankly, the work is great for showing people with "normal eating behaviours" how distorted perceptions of beauty have become. But those truly in danger — anorexics and bulimics — are perhaps less well-served by the shock factor.

For many of them, the contrast of exposed hipbones to the fleshiness of older muses is an improvement, not a travesty. As one YouTube commenter eerily put it:

“using irony to get your point across is lost on someone with anorexia. we will merely see skeletal bodies being displayed as art they way they should be. hope this made you some﻿ money.”

"The way they should be": those words ring louder than any intellectual accolade proffered by someone not suffering from an eating disorder. It’s a perspective worth keeping in mind when managing a similar type of client.

Symptoms of eating disorders tend to fluctuate over time, meaning that people can move rather fluidly between anorexia and bulimia and the EDNOS diagnosis. David Herzog's group at Harvard University tried to determine how to classify diagnoses of EDNOS after AN or BN: was it a separate diagnosis or part of the spectrum of illness and symptoms seen in anorexia and bulimia? This study indicates that it should be the latter.

Individuals with AN most often developed subthreshold presentations resembling AN; those with BN were more likely to develop subthreshold BN. Purging disorder was experienced by half of those with BN and one-quarter of those with AN binge/purge type (ANBP); BED occurred in 20% with BN. Transition from AN or BN to most subthreshold types was associated with improved psychosocial functioning...Subthreshold presentations in women with lifetime AN and BN were common, resembled the initial diagnosis, and were associated with modest improvements in psychosocial functioning. For most with lifetime AN and BN, subthreshold presentations seem to represent part of the course of illness and to fit within the original AN or BN diagnosis.

With regard to the first article on osteoporosis... Dare I state that I am something of an 'expert' on this topic? At least, it is an area in which I have published quite a number of papers as a post-doc. I made a video on my youtube channel that describes some of my research so I won't elaborate here.

To summarise: the mechanism of osteoporosis is anorexia nervosa (AN) is quite different to that of post-menopausal oestrogen deficiency in that there is significantly reduced bone formation (as well as increased bone resorption) in AN. The extent to which bone formation is reduced in AN depends upon the magnitude of energy deprivation - on a day-to-day basis, and over time (as reflected by the duration for which BMI is significantly lowered). The lowest bone densities are observed in people who developed AN pre-puberty, spent their teen years with AN, and who have a long history of AN.

And YES, I also hate this assumed idea that anorexia = beauty and so we become anorexic and sacrifice our health in order to be beautiful. AN is soooo NOT beautiful, and I never put myself through years of stress and heartache simply to have a 'perfect body' (whatever that is...).

That study on bone density was reported in the British newspapers this week as well. I developed osteopenia after ten months without my period. After getting it back once I relapsed again and lost it for another year. I am back at a healthy weight now and anxiously awaiting my next DEXA scan in the summer. Ack. Scares the whatsit out of me too now I'm healthy, but it barely registered as a concern when I was ill. I agree that scare tactics rarely work on people with eating disorders.

I am always interested in studies which look into the course of eating disordered symptoms. I am a bit of an oddity in that I went from non-purging bulimia in my teens to anorexia in my 20s - I believe that most people seem to jump the fence in the other direction, but I stopped bingeing and overexercising after ten years of eating disorder and then became anorexic. There was a definite difference in ability to function between the two - when I was anorexic I did well academically but was a complete hermit socially, and I got too ill to continue at university very quickly. When I fit the definition of EDNOS better I was more volatile and I think I was more at risk of suicide, but I kept going to school and socialising. I have always suspected that all eating disorders are much the same illness, only the biological effects of erratic/restrictive eating affects different people in different ways - some start bingeing and sometimes purging, some become sort of addicted to starvation. I have yet to see how I manage this day to day functioning business without any eating disorder at all!

that was a very interesting sunday smorgasboard! i love reading your blog, and it's just what i need right now. i am trying to maintain a healthy body weight when it seems the rest of the world is trying to lose weight in the new year!!!

I just about died over your first feline interlude--my cats are so fluffy it's disturbing. And they look huge until you pick them up and realize it really is 90% fluff.

Like everyone else, losing bone mass really didn't bother me when I was sick. Now it's definitely a motivation to stay well but a research study would not have made me care about my bones then (and believe me, I had several waved at me). I also think the whole "changing famous art" video was really irrelevant to eating disorders. It drives me nuts that people think these things are actually helpful or relevant to eating disorders and largely shows how much ignorance about eating disorders are out there.

Thanks for taking the time to discuss this, I feel strongly about it and love learning more on this topic. If possible, as you gain expertise, would you mind updating your blog with more information? It is extremely helpful for me.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.